Consumer Information—Cannabis (Marihuana, Marijuana)

Consumer Information—Cannabis (Marihuana, marijuana)

Help on accessing alternative formats, such as Portable Document Format (PDF), Microsoft Word and PowerPoint (PPT) files, can be obtained in the alternate format help section. The courts in Canada have ruled that the federal government must provide reasonable access to a legal source of marijuana for medical purposes. The legal sources of cannabis for medical purposes are licensed producers, personal production and designated production. A complete list of licensed producers can be found on the Health Canada website. Cannabis is not an approved therapeutic product and the provision of this information should not be interpreted as an endorsement of the use of cannabis for therapeutic purposes, or of marijuana generally, by Health Canada. This leaflet is designed by Health Canada for patients authorized to possess cannabis for medical purposes. It is based on the document “Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the Cannabinoids”, and is a summary only – it will not provide you with all the facts about cannabis for medical purposes. Contact your health care practitioner if you have any questions.

Serious Warnings and Precautions »» Keep any fresh or dried marijuana and »» Smoking cannabis is not recommended. cannabis oil out of reach of children. Do not smoke or vapourize cannabis in »» Cannabis (marihuana, marijuana) the presence of children. contains hundreds of substances, »» Using cannabis or any cannabis some of which can affect the proper product can impair your concentration, functioning of the brain and central your ability to think and make nervous system. decisions, and your reaction time and »» The use of this product involves risks coordination. This can affect your to health, some of which may not be motor skills, including your ability to known or fully understood. Studies drive. It can also increase anxiety and supporting the safety and efficacy of cause panic attacks, and in some cases cannabis for therapeutic purposes are cause paranoia and hallucinations. limited and do not meet the standard »» Cognitive impairment may be greatly required by the Food and Drug increased when cannabis is consumed Regulations for marketed drugs in along with alcohol or other drugs which Canada. affect the activity of the nervous system (e.g. opioids, sleeping pills, other psychoactive drugs). 2 Consumer Information—Cannabis (Marihuana, marijuana)

About This Product What the other ingredients might be There are over 70 different cannabinoids What the product may be used for as well as hundreds of other chemicals in Your health care practitioner may have cannabis. Many of the chemicals found in authorized the use of cannabis (marihuana, tobacco smoke are also found in cannabis marijuana) for the relief of one or more of smoke. the following symptoms associated with a variety of disorders which have not responded What the product does to conventional medical treatments. These One of the principal active ingredients in symptoms (or conditions) may include: cannabis (THC) acts on very specific targets severe refractory nausea and vomiting found in the body known as cannabinoid associated with cancer chemotherapy; receptors. Other cannabinoids, such as loss of appetite and body weight in cancer CBD, may also have targets other than patients and patients with HIV/AIDS; pain the cannabinoid receptors. Cannabinoid and muscle spasms associated with multiple receptors are found throughout the body, sclerosis; chronic non-cancer pain (mainly in most tissues and organs, but they are neuropathic); severe refractory cancer- especially numerous in the brain and nervous associated pain; insomnia and depressed system. Cannabinoid receptors are involved mood associated with chronic diseases in the regulation of many bodily functions (HIV/AIDS, chronic non-cancer pain); and including: brain and nervous system activity, symptoms encountered in the palliative/end- heart rate and blood pressure, digestion, of-life care setting. This is not an exhaustive inflammation, immune system activity, list of symptoms or conditions for which perception of pain, reproduction, wake/sleep cannabis may be authorized for use by your cycle, regulation of stress and emotional state health care practitioner. and many other functions. For more detailed The potential therapeutic and adverse information, please consult the “Information effects associated with cannabis use may for Health Care Professionals: Cannabis vary depending on the amount of cannabis (marihuana, marijuana) and the used and the concentration of cannabinoids Cannabinoids”. in the cannabis product, the frequency of cannabis use, the patient’s age and When the product should not be used medical condition, previous experience Cannabis should not be used if you: with cannabis or cannabinoids, and the use of other prescription or non-prescription »» are under the age of 25 drugs. For more detailed information on »» are allergic to any cannabinoid or to smoke potential therapeutic uses and adverse effects, please consult the “Information for Health »» have serious liver, kidney, heart or lung Care Professionals: Cannabis (marihuana, disease marijuana) and the Cannabinoids”. »» have a personal or family history of serious mental disorders such as schizophrenia, What the active ingredients might be psychosis, depression, or bipolar disorder »» Tetrahydrocannabinol (THC) »» are pregnant, are planning to get pregnant, or are breast-feeding »» Cannabidiol (CBD) »» are a man who wishes to start a family The type and amount of these ingredients may vary depending on the cannabis strain. »» have a history of alcohol or drug abuse or substance dependence 3 Consumer Information—Cannabis (Marihuana, marijuana)

Talk to your health care practitioner if you There are a small number of clinical studies have any of these conditions. There may be of short duration with smoked/vapourized other conditions where this product should cannabis for therapeutic purposes. Smoking/ not be used, but which are unknown due to vapourizing cannabis results in a more rapid limited scientific information. onset of action (within minutes), higher blood levels of cannabinoids, and a shorter duration of acute effects compared to oral ingestion. Interactions with this Product While there are no established dosing Cannabis may interact with several drugs. guidelines for smoking/vapourizing cannabis Make sure to tell your health care practitioner for therapeutic purposes, it is prudent to which prescription drugs, non-prescription proceed slowly and cautiously in a gradual drugs or herbal products you are currently fashion, waiting between puffs or inhalations taking, particularly: for a minimum of 30 minutes to gauge for strength of effects or for possible overdosing. »» Any drugs which slow down the central A dosing increase should be carried out nervous system, causing drowsiness. These slowly, only if required, and only until you may include sleeping pills, tranquilizers, reach a comfortable dose. some pain medications, some allergy or cold medications, or anti-seizure In contrast to smoked/vapourized cannabis, medications. there are no clinical studies of cannabis-based edible products for therapeutic purposes »» Other drugs may include antiretroviral (e.g. oils, foods). Absorption of cannabinoids drugs used in the treatment of HIV/AIDS, by the oral route is known to be slow and certain anti-depressants, stomach acid erratic, and the onset of acute effects is inhibitors, certain antibiotic and antifungal delayed with the acute effects generally medications, certain heart medications, lasting much longer compared to smoking/ and Saint John’s Wort. vapourizing. Furthermore, dosages for orally administered products are even less well- established than for smoking/vapourization. Dosing Information and Routes These particularities have contributed to of Administration overdoses with some orally administered There is no scientifically defined dose of products. If ingesting cannabis orally (e.g. cannabis for any specific medical condition. in oils, foods) wait a minimum of 2 hours If you have not consumed cannabis before, between administration of single doses of oral it would be prudent to have someone with products to gauge for strength of effects or for you the first time you use it. Dosing remains possible overdosing. highly individualized and relies greatly on titration (i.e. finding the right dose where Stop using cannabis right away and consult potential therapeutic effects are maximized your health care practitioner if you begin to while adverse effects are minimized). The experience any side effects (see side effects current available information suggests most section for additional information). individuals use less than 3 grams daily of Please consult the “Daily amount and dried marijuana, whether that amount is taken dosing information fact sheet” for additional orally, inhaled, or a combination of both. information on dosing. Patients with no prior experience with cannabis or cannabinoids are cautioned to begin at a very low dose and to stop therapy if unacceptable or undesirable effects occur. 4 Consumer Information—Cannabis (Marihuana, marijuana)

Overdose »» suspiciousness, nervousness, episodes of anxiety resembling a panic attack, paranoia Symptoms of overdose may include: (loss of contact with reality), hallucinations sleepiness, confusion, disorientation, (seeing or hearing things that do not exist); clumsiness/loss of coordination, fainting, dizziness, chest pain, fast, slow or pounding »» impairments in motor skills and heartbeat, panic attacks, loss of contact with perception, altered bodily perceptions, loss reality, and seizures. of full control of bodily movements, falls; »» dry mouth, throat irritation, coughing; Seek immediate medical attention in case of overdose, and especially if experiencing chest »» worsening of seizures; pain, panic attacks, loss of contact with reality, »» hypersensitivity reactions (contact or seizures. dermatitis/hives); Cannabis should be used with caution in »» higher or lower blood levels of certain patients receiving concomitant therapy medications; with other psychoactive drugs because of »» nausea, vomiting; and the potential for greatly enhanced effects »» fast heartbeat. on the brain and other parts of the nervous system. An overdose can also occur if a Long term use may patient is smoking/vapourizing cannabis »» increase the risk of triggering or and at the same time consuming orally aggravating psychiatric and/or mood administered cannabinoids whether from disorders (schizophrenia, psychosis, prescription cannabinoid medications, or anxiety, depression, bipolar disorder); from consumption of oils, teas, baked goods or other products. »» increase the risk of developing respiratory infections or chronic cough (when smoking); Side Effects and What To Do »» decrease sperm count, concentration and About Them motility, and increase abnormal sperm morphology; The information on side effects associated with therapeutic use of cannabis is limited. »» negatively impact the behavioural and Some of the more well-known side effects are cognitive development of children born intoxication-like reactions including: to mothers who used cannabis during pregnancy; »» dizziness, drowsiness, feeling faint or »» negatively affect cognitive functions lightheaded, fatigue, headache; (ability to think and make decisions); »» impaired memory and disturbances in »» lead to a decrease in one or more of the attention, concentration and ability to effects of cannabis (tolerance); think and make decisions; »» lead to withdrawal-type symptoms when »» disorientation, confusion, feeling drunk, use is abruptly halted or discontinued. feeling abnormal or having abnormal Withdrawal symptoms may include thoughts, feeling “too high”, feelings of anger or aggression, irritability, anxiety, unreality, feeling an extreme slowing of nightmares/strange dreams, insomnia/ time; sleep difficulties, craving, headache, restlessness, and decreased appetite or weight loss, depressed mood, chills, stomach pain, shakiness and sweating; and 5 Consumer Information—Cannabis (Marihuana, marijuana)

»» result in psychological dependence »» Report online (addiction) which is characterized by »» Call toll-free at 1-866-234-2345 impaired control over drug use, compulsive use, continued use despite harm, and »» Complete a Canada Vigilance Reporting craving. Form and: • Fax toll-free to 1-866-678-6789, or This is not a complete list of side effects. • Mail to: If you experience any side effects or any Canada Vigilance Program unexpected effects while using cannabis for Health Canada medical purposes, stop consuming cannabis Postal Locator 0701D immediately and contact a health care Ottawa, Ontario K1A 0K9 practitioner or the emergency department of your nearest hospital. Postage paid labels, Canada Vigilance Reporting Form and the adverse reaction How the product is supplied reporting guidelines are available on Dried marijuana plant material, fresh the MedEffect™ Canada Web site. marijuana plant material and products derived from fresh or dried marijuana. NOTE: Should you require information related to the management of side effects, contact your health care practitioner. The Canada How to store the product Vigilance Program does not provide medical Dried marijuana plant material and cannabis advice. products should be stored in a cool place, preferably away from light and air. See manufacturer’s instructions on the product More Information label for recommended storage conditions. This document plus the full information Keep any cannabis and cannabis products out prepared for health professionals of the reach of children and locked in a safe (the”Information for Health Care place to prevent theft, misuse and accidental Professionals: Cannabis (marihuana, ingestion by children. This product should marijuana) and the Cannabinoids”) as well not be shared with anyone else. as information on dosing can be found on the Health Canada website. Reporting Suspected Side Effects This leaflet was prepared by Health Canada. You can report any suspected adverse reactions associated with the use of this Date of latest version July 2016 product to the Canada Vigilance Program by one of the following 3 ways:

Pub. : 160110